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Application To Purchase Age 29 Young Adult Coverage - UFT Welfare Fund Benefits Only

Complete a separate application for Young Adult Coverage for each dependent child between the ages of 26-29 for whom you are requesting coverage by the UFT Welfare Fund.

Training Record Form – Informal Providers

Informal providers should use this form to record any training sessions they attend. Informal providers who complete 10 or more hours of approved training in at least two different approved topics may be eligible to receive a higher, "enhanced"...

DB-450: Disability Claim

Complete this form to claim disability benefits only if your Workers’ Compensation claim has been rejected.

Prescription Appliance and/or Medical Equipment Claim Form - HIP Subscribers Only

For HIP subscribers only, includes a section for member and physician to fill out. Please attach original, itemized, paid bill showing date and item purchased.

Transit Benefit Program Enrollment Form

Save more than $200 each year in taxes by participating in the city’s TransitChek program.

NY Workers Comp Weekly Wage Benefit

The amount of weekly benefits you receive during your period of disability is based on the average weekly wage you were earning at the time of your injury. Initially, you should receive approximately 2/3 of your wages. However, the workers...

C-11: Change of Employment Status

Change in employment status includes return to work, discontinuance of work, increase or decrease of regular hours of work and increase or reduction of wages.

DHHES - DOE HES Audiological Medical Clearance form 2022-23

Membership Application (all DOE titles except paraprofessionals)

UFT membership application for all DOE titles except paraprofessionals. Print, complete and submit this application form only if you are not able to use the UFT's online enrollment form.

Retiree Toolkit: Turning 65/Applying for Medicare

Booklet about applying for Medicare once a member turns 65

SESIS grievance form

If you have performed SESIS-related activities at home because you have been directed to do so, you can file a grievance within thirty (30) school days from the time you were instructed to perform the activity.

Durable Medical Equipment Deductible Reimbursement Form - NYCE PPO in-service subscribers only

For NYCE PPO in-service members only, the Welfare Fund will reimburse up to $100/year of the deductible for the purchase or rental of durable medical equipment, with this form and an original Explanation of Benefits (EOB).

Chancellor's Reg. A832 re student-to-student discrimination, harassment, intimidating and/or bullying

Chancellor's Regulation A-832: This regulation establishes a procedure for the filing, investigation, and resolution of complaints of student-to-student discrimination, harassment, intimidation, and/or bullying.

Federation of Nurses/UFT Investigation Fact Sheet

Advance at a Glance - key dates for teacher evaluation

Key Dates and Reminders for the School Year

Measures of Student Learning (MOSL) Guide

A DOE guide to Measures of Student Learning (MOSL) in the teacher evaluation system.

Market Rate Application Form – Informal Providers

Moving forward, all informal providers will receive the standard 2007 market rate without having to apply. In order to receive the 2007 rate retroactively, informal providers must apply for it and attest that their cost of care has increased. Please...

Market Rate Application Form – Registered Family and Licensed Group Providers

Registered family and licensed group providers whose rates listed on file with ACS are not already higher than the 2007 market rate should use this form to apply to receive the new market rate moving forward and retroactively.

Veterans' credit verification request form

Required DOE forms to file for Workers' Compensation

If you are filing for workers’ compensation, you must file these forms:

OP 44: Application for Termination Pay for Pedagogues

Upon resignation, termination or retirement, pedagogues are entitled to receive half of their sick leave balance (up to 100 days).

Provider/Program Enrollment or Update Request Form

Administration for Children's Services Division of Child Care/Head Start Child Care Support Services; Provider / Program Enrollment or Update Request

HIPAA: Protected Health Information Authorization Form (PHI Form)

You may authorize the UFT to use/disclose your protected health information by filling out this form.

School-based plan to support immigrant students and families

The UFT has developed this worksheet to support the work of school-based committees to defend immigrants. It can help committees identify questions, locate current policies and find resources to protect the students they serve.

MD-1: Request for Medical Authorization

Here is the form for an attending doctor to obtain medical authorization:

DOE Payroll Administration Memorandum - new process for mailing paper checks

As of Oct. 2024, DOE employees not enrolled in direct deposit and are not in the H/Z bank payroll system will have their checks mailed to their address on file with the DOE directly from JP Morgan Chase bank. The NYCPS Bureau of Check Management will...

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